RIvER Clinic: Rethinking Incarceration and Empowering Recovery-An Innovative Postincarceration Care Delivery Model Implemented During the COVID-19 Pandemic.

The Rethinking Incarceration and Empowering Recovery (RIvER) Clinic was launched in June 2021 to address the health disparities experienced during and after incarceration. The RIvER Clinic's multidisciplinary, community-centered team engages patients during jail detention and after release via telehealth, collocated in community locations, on a mobile van, and in clinic. The clinic serves as a bridge between incarceration and the establishment of permanent health care and social services in the community. In 2022, a total of 479 visits were completed. The clinic provided multidisciplinary substance use support to all eligible patients, paying for 104 medication for opioid use disorder (MOUD) prescriptions for uninsured patients. Twenty-five percent of patients were transitioned to community-based care, and less than 5% of patients were reincarcerated. Despite some limitations, results demonstrate that the RIvER Clinic is successfully reintegrating a marginalized population into its community. The purpose of this article is to describe the implementation and preliminary outcomes of this postincarceration clinic.

The relationship of PrEP beliefs to perceived personal, interpersonal and structural benefits and barriers to PrEP use in women who inject drugs.

BACKGROUND: Women who inject drugs (WWID) have significant biological, behavioral, and gender-based barriers to accessing HIV prevention services, including Pre-Exposure Prophylaxis (PrEP) medication. Little is known about how beliefs about PrEP impact both perceived barriers and benefits of PrEP use and how they may be related to the decision-making process. METHODS: Surveys were conducted with 100 female clients of a large syringe services program in Philadelphia, Pennsylvania. The sample was categorized into three groups based on mean PrEP beliefs scores using terciles: accurate beliefs, moderately accurate beliefs, and inaccurate beliefs. Oneway ANOVA tests were used to compare groups by perceived benefits and barriers to PrEP, drug use stigma, healthcare beliefs, patient self-advocacy, and intention to use PrEP. RESULTS: Participants had a mean age of 39 years (SD 9.00), 66% reported being White, 74% finished high school, and 80% reported having been homeless within the past 6 months. Those with the most accurate PrEP beliefs reported highest intent to use PrEP and were more likely to agree that benefits of PrEP included it preventing HIV and helping them "feel in charge". Those with inaccurate beliefs were more likely to strongly agree that barriers, such as fear of reprisal from a partner, potential theft, or feeling they "might get HIV anyway", were reasons not to use PrEP. CONCLUSIONS: Results indicate perceived personal, interpersonal and structural barriers to PrEP use are associated with accuracy of beliefs is, pointing to important intervention targets to increase uptake among WWID.

Interventions Designed to Improve HIV Continuum of Care Outcomes for Persons with HIV in Contact with the Carceral System in the USA.

PURPOSE OF REVIEW: To describe existing evidence and identify future directions for intervention research related to improving HIV care outcomes for persons with HIV involved in the carceral system in the USA, a population with high unmet HIV care needs. RECENT FINDINGS: Few recent intervention studies focus on improving HIV care outcomes for this population. Successful strategies to improve care outcomes include patient navigation, substance use treatment, and incentivizing HIV care outcomes. Technology-supported interventions are underutilized in this population. Notable gaps in the existing literature include intervention research addressing HIV care needs for cisgender and transgender women and those under carceral supervision in the community. Future research should address existing gaps in the literature and respond to emergent needs including understanding how the changing HIV care delivery environment resulting from the COVID-19 pandemic and the approval of new injectable ART formulation shape HIV care outcomes in this population.

Multilevel Factors Shaping Awareness of and Attitudes Toward Pre-exposure Prophylaxis for HIV Prevention among Criminal Justice-Involved Women.

Although pre-exposure prophylaxis (PrEP) is a key tool in HIV prevention efforts, little is known about PrEP as a prevention strategy for criminal justice-involved (CJI) women. The purpose of this study was to examine multilevel factors shaping PrEP awareness and acceptability among CJI women. Between January 2017 and December 2017, we conducted 52 interviews with CJI women at high risk for HIV and stakeholders from the criminal justice (CJ) and public health (PH) systems. Interviews explored awareness of PrEP and the multilevel factors shaping PrEP acceptability. Data were analyzed using inductive thematic analysis and executive summaries. Atlas.ti facilitated analyses. The majority of CJI women (n = 27) were, on average, 41.3 years, from racial and ethnic minority groups (56% Black/African-American; 19% Latinx) and reported engaging in recent high-risk behavior (nearly 60% engaged in transactional sex, 22% reported ≥ 4 sexual partners, and 37% reported injection drug use). Of system stakeholders (n = 25), 52% represented the CJ sector. Although CJI women were generally unaware of PrEP, attitudes toward PrEP were enthusiastic. Barriers to PrEP acceptability included medication side effects (individual level); distrust in HIV prevention mechanisms (community level); lack of local HIV prevention efforts among high-risk women (public policy/HIV epidemic stage level). Factors promoting PrEP included perceived HIV risk (individual level); PrEP being an HIV prevention method that women can control without partner negotiation (social and sexual network level); and availability of public health insurance (community level). Despite low awareness of PrEP, CJI women expressed positive attitudes toward PrEP. To improve PrEP access for CJI women, implementation efforts should address barriers and leverage facilitators across multiple levels to be maximally effective.

Justice involvement and girls' sexual health: Directions for policy and practice.

Arrested girls in the United States (US) are often diverted from detention through referrals to juvenile specialty courts (e.g., juvenile drug court), community-based diversion programs, or pre-adjudicated probation services. Limited research suggests that sexual and reproductive health needs for diverted, or court-involved, non-incarcerated (CINI) girls are similar to that of their detained counterparts. Despite the US justice system's emphasis on diverting youth from detention, research and programmatic efforts to improve sexual and reproductive health outcomes has primarily focused on detained girls. Policy and programming for CINI girls is scant and thus warrants further attention. This report details the immediate sexual and reproductive health needs of CINI girls. We discuss implications of current health care policies and practices for this population and conclude with recommendations for research focused on improving access to sexual and reproductive health care.

Changing Places and Partners: Associations of Neighborhood Conditions With Sexual Network Turnover Among African American Adults Relocated From Public Housing.

Neighborhood conditions and sexual network turnover have been associated with the acquisition of HIV and other sexually transmitted infections (STIs). However, few studies investigate the influence of neighborhood conditions on sexual network turnover. This longitudinal study used data collected across 7 visits from a predominantly substance-misusing cohort of 172 African American adults relocated from public housing in Atlanta, Georgia, to determine whether post-relocation changes in exposure to neighborhood conditions influence sexual network stability, the number of new partners joining sexual networks, and the number of partners leaving sexual networks over time. At each visit, participant and sexual network characteristics were captured via survey, and administrative data were analyzed to describe the census tracts where participants lived. Multilevel models were used to longitudinally assess the relationships of tract-level characteristics to sexual network dynamics over time. On average, participants relocated to neighborhoods that were less economically deprived and violent, and had lower alcohol outlet densities. Post-relocation reductions in exposure to alcohol outlet density were associated with fewer new partners joining sexual networks. Reduced perceived community violence was associated with more sexual partners leaving sexual networks. These associations were marginally significant. No post-relocation changes in place characteristics were significantly associated with overall sexual network stability. Neighborhood social context may influence sexual network turnover. To increase understanding of the social-ecological determinants of HIV/STIs, a new line of research should investigate the combined influence of neighborhood conditions and sexual network dynamics on HIV/STI transmission over time.

Male Incarceration Rates and Rates of Sexually Transmitted Infections: Results From a Longitudinal Analysis in a Southeastern US City.

BACKGROUND: In the United States, rates of certain sexually transmitted infections (STIs) are increasing. Contextual factors seem to play an important role in shaping STI transmission dynamics. This longitudinal study explores the relationship between one contextual determinant of health (the male incarceration rate) and rates of newly diagnosed STIs in census tracts in Atlanta, GA. METHODS: The sample consisted of all census tracts in Atlanta (n = 946). Annual data on STI diagnoses were drawn from the Georgia surveillance system for 2005 to 2010; annual male incarceration data were drawn from the Georgia Department of Corrections for 2005 to 2010; and data on potential confounders were drawn from the US Census. Multivariable growth models were used to examine the association between the male incarceration rate and rates of newly diagnosed STIs, controlling for covariates. RESULTS: Census tracts with higher baseline male incarceration rates had a higher baseline rate of newly diagnosed STIs. Census tracts with increasing male incarceration rates experienced a more rapid increase in their rate of newly diagnosed STIs. Census tracts with medium and high baseline male incarceration rates experienced a decrease in their rate of newly diagnosed STIs over time. CONCLUSIONS: The present study strengthens the evidence that male incarceration rates have negative consequences on sexual health outcomes, although the relationship may be more nuanced than originally thought. Future multilevel research should explore individual sexual risk behaviors and networks in the context of high male incarceration rates to better understand how male incarceration shapes rates of STIs.

Changes in Exposure to Neighborhood Characteristics are Associated with Sexual Network Characteristics in a Cohort of Adults Relocating from Public Housing.

Ecologic and cross-sectional multilevel analyses suggest that characteristics of the places where people live influence their vulnerability to HIV and other sexually-transmitted infections (STIs). Using data from a predominately substance-misusing cohort of African-American adults relocating from US public housing complexes, this multilevel longitudinal study tested the hypothesis that participants who experienced greater post-relocation improvements in economic disadvantage, violent crime, and male:female sex ratios would experience greater reductions in perceived partner risk and in the odds of having a partner who had another partner (i.e., indirect concurrency). Baseline data were collected from 172 public housing residents before relocations occurred; three waves of post-relocation data were collected every 9 months. Participants who experienced greater improvements in community violence and in economic conditions experienced greater reductions in partner risk. Reduced community violence was associated with reduced indirect concurrency. Structural interventions that decrease exposure to violence and economic disadvantage may reduce vulnerability to HIV/STIs.

Collateral consequences: implications of male incarceration rates, imbalanced sex ratios and partner availability for heterosexual Black women.

While studies have found correlations between rates of incarceration and sexually transmitted infections (STIs), few studies have explored the mechanisms linking these phenomena. This qualitative study examines how male incarceration rates and sex ratios influence perceived partner availability and sexual partnerships for heterosexual Black women. Semi-structured interviews were conducted with 33 Black women living in two US neighbourhoods, one with a high male incarceration rate and an imbalanced sex ratio (referred to as 'Allentown') and one with a low male incarceration rate and an equitable sex ratio (referred to as 'Blackrock'). Data were analysed using grounded theory. In Allentown, male incarceration reduced the number of available men, and participants largely viewed men available for partnerships as being of an undesirable quality. The number and desirability of men impacted on the nature of partnerships such that they were shorter, focused on sexual activity and may be with higher-risk sexual partners (e.g. transactional sex partners). In Blackrock, marriage rates contributed to the shortage of desirable male partners. By highlighting the role that the quantity and quality of male partners has on shaping sexual partnerships, this study advances current understandings of how incarceration and sex ratios shape HIV- and STI-related risk.

Orienting patients to greater opioid safety: models of community pharmacy-based naloxone.

The leading cause of adult injury death in the U.S.A. is drug overdose, the majority of which involves prescription opioid medications. Outside of the U.S.A., deaths by drug overdose are also on the rise, and overdose is a leading cause of death for drug users. Reducing overdose risk while maintaining access to prescription opioids when medically indicated requires careful consideration of how opioids are prescribed and dispensed, how patients use them, how they interact with other medications, and how they are safely stored. Pharmacists, highly trained professionals expert at detecting and managing medication errors and drug-drug interactions, safe dispensing, and patient counseling, are an under-utilized asset in addressing overdose in the U.S. and globally. Pharmacies provide a high-yield setting where patient and caregiver customers can access naloxone-an opioid antagonist that reverses opioid overdose-and overdose prevention counseling. This case study briefly describes and provides two US state-specific examples of innovative policy models of pharmacy-based naloxone, implemented to reduce overdose events and improve opioid safety: Collaborative Pharmacy Practice Agreements and Pharmacy Standing Orders.

A perfect storm: crack cocaine, HSV-2, and HIV among non-injecting drug users in New York City.

Prevalence of human immunodeficiency virus (HIV) infection has reached 16% among non-injecting drug users (NIDU) in New York City, an unusually high prevalence for a predominantly heterosexual population that does not inject drugs. Using a long-term study (1983-2011, >7,000 subjects) among persons entering the Beth Israel drug-treatment programs in New York City, we identified factors that contributed to this high prevalence: a preexisting HIV epidemic among injectors, a crack cocaine epidemic, mixing between injectors and crack users, policy responses not centered on public health, and herpes-simplex virus 2 facilitating HIV transmission. Implications for avoiding high prevalence among NIDU in other areas are discussed.

eHealth-Enhanced Peer Navigation for Substance Use Treatment and HIV Prevention Service Linkage for Young Adults Surveilled by the Criminal Legal System: Protocol for a Pilot Randomized Trial Study.

BACKGROUND: In the United States, the proportion of criminal legal-involved (CLI) adults with a substance use disorder reaches 72%, and ~150,000 persons with HIV pass through a carceral setting annually, which represents 16% of the HIV-infected population nationally. Despite the high need for substance use treatment and HIV prevention services, few carceral settings successfully link CLI individuals to treatment upon release. Young adults represent 41.9% of the adults incarcerated in the United States and have the highest HIV incidence rates nationally. Peer patient navigation has successfully increased community-based care linkage for people living with HIV leaving jail; yet, peer-led navigation for HIV prevention among HIV-negative CLI populations is undeveloped and untested. eHealth approaches to substance use and HIV prevention services hold promise because they improve access to effective intervention services, particularly for younger people. OBJECTIVE: This paper describes a protocol for a pilot randomized controlled trial that aims to improve linkage to substance use treatment and HIV prevention services using peer navigation and a codeveloped eHealth technology adjunct. METHODS: The three aims of this study are to (1) adapt an existing evidence-based navigator model and incorporate codeveloped eHealth technology to refer and link young adults (18 to 29 years) surveilled by the criminal legal system to substance use and pre-exposure prophylaxis (PrEP) services; (2) refine and test the intervention with criminal legal-involved young adults (CLI-YAs); and (3) assess the feasibility, acceptability, and impact of the intervention. Data to inform the intervention will be collected via system partner interviews (n=4) and focus groups with CLI-YAs (n=24). Next, an open trial (n=10) will be conducted. The intervention will be refined via interviews with participants and facilitators, and a randomized pilot trial (n=75) will be conducted to assess the feasibility, acceptability, and preliminary impact of the eHealth-enhanced navigation on substance use and PrEP services linkage. Exit interviews conducted with a subsample of intervention participants (n=10), the navigator (n=1), and system partners (n=4) will assess intervention acceptability and suggestions for improvement. A community of practice, a group of system partners with an interest in working toward solutions to common problems, will inform each phase of the study. RESULTS: The project is currently ongoing. The project was funded in September 2022. Internal review board approval was received on March 21, 2022. The first results from early study aims are expected to be published in 2025. CONCLUSIONS: This study provides an opportunity to reduce HIV acquisition and improve access to substance use treatment in a systemically marginalized group: young CLI-YAs. The results will contribute to the development and testing of a future multilevel randomized controlled trial. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/54815.

Identifying Implementation Determinants and Strategies for Long-Acting Injectable Cabotegravir-Rilpivirine in People With HIV Who Are Virally Unsuppressed.

BACKGROUND: Early evidence suggests long-acting injectable cabotegravir and rilpivirine (LA-CAB/RPV) may be beneficial for people with HIV (PWH) who are unable to attain viral suppression (VS) on oral therapy. Limited guidance exists on implementation strategies for this population. SETTING: Ward 86, a clinic serving publicly insured PWH in San Francisco. METHODS: We describe multilevel determinants of and strategies for LA-CAB/RPV implementation for PWH without VS, using the Consolidated Framework for Implementation Research. To assess patient and provider-level determinants, we drew on pre-implementation qualitative data. To assess inner and outer context determinants, we undertook a structured mapping process. RESULTS: Key patient-level determinants included perceived ability to adhere to injections despite oral adherence difficulties and care engagement challenges posed by unmet subsistence needs; strategies to address these determinants included a direct-to-inject approach, small financial incentives, and designated drop-in days. Provider-level determinants included lack of time to obtain LA-CAB/RPV, assess injection response, and follow-up late injections; strategies included centralizing eligibility review with the clinic pharmacist, a pharmacy technician to handle procurement and monitoring, regular multidisciplinary review of patients, and development of a clinic protocol. Ward 86 did not experience many outer context barriers because of rapid and unconstrained inclusion of LA-CAB/RPV on local formularies and ability of its affiliated hospital pharmacy to stock the medication. CONCLUSIONS: Multilevel strategies to support LA-CAB/RPV implementation for PWH without VS are required, which may necessitate additional resources in some settings to implement safely and effectively. Advocacy to eliminate outer-context barriers, including prior authorizations and specialty pharmacy restrictions, is needed.

"Good luck, social distance": rapid decarceration and community care for serious mental illness and substance use disorder during the COVID-19 pandemic.

The COVID-19 pandemic inspired calls for rapid decarceration of prisons and jails to slow the spread of disease in a high-risk congregate setting. Due to the rarity of intentionally-decarcerative policies, little is known about the effects of rapid decarceration on individuals with serious mental illness (SMI) substance use disorder (SUD), a population who receive many services via the criminal legal system (CLS). We conducted interviews with 13 key informants involved in CLS in San Francisco, CA to better understand the implication of the decarcerative policies put into practice in early 2020. Participants described a tension between the desire to have fewer people incarcerated and the challenges of accessing services and support - especially during the lockdown period of the pandemic - outside of the CLS given the number of services that are only accessible to those who have been arrested, incarcerated, or sentenced. These findings emphasize the need for investing in community social services rather than further expanding the CLS to achieve the goal of supporting individuals with SMI and SUD shrinking the US system of mass incarceration.

Psychiatric and Substance-Related Problems Predict Recidivism for First-Time Justice-Involved Youth.

Justice-involved youth with clinically significant co-occurring psychiatric and substance-related problems are at increased risk for recidivism. Less is known about how psychiatric symptoms (i.e., internalizing and externalizing) and substance-related problems (i.e., alcohol and cannabis) interact to predict recidivism, especially at first court contact. Among 361 first-time justice-involved youth aged 12 to 18, we used nested multivariate negative binomial regression models to examine the association between psychiatric symptoms, substance-related problems and 24-month recidivism while accounting for demographic and legal covariates. Clinically significant externalizing symptoms and alcohol-related problems predicted recidivism. Moderation analyses revealed that alcohol-related problems drove recidivism for youth without clinically significant psychiatric symptoms and externalizing symptoms predicted recidivism, regardless of alcohol-related problems. After accounting for other predictors, Latinx, Black non-Latinx, and multiracial non-Latinx youth were more likely to recidivate at follow-up than White non-Latinx youth. Systematic screening, referral, and linkage to treatment for psychiatric and substance-related problems are needed to reduce recidivism risk among first-time justice-involved youth. Differences in recidivism rates by race/ethnicity not attributable to behavioral health needs suggest it is imperative to concurrently deploy large-scale structural interventions designed to combat systemic racial bias and overrepresentation of ethnoracial minoritized youth within the juvenile justice system.

Leveraging Technology to Increase Behavioral Health Services Access for Youth in the Juvenile Justice and Child Welfare Systems: a Cross-systems Collaboration Model.

Behavioral health services access for justice- and child welfare-involved youth is limited despite significant need. Structural interventions to address limited access are nascent. Technology can advance access, but few interventions focus on system-impacted youth and their mental health needs and challenges. This article describes the development, process, and initial outcomes of the Youth Justice and Family Well-Being Technology Collaborative (JTC) that was formed to leverage technology within and across public health and justice-related systems to promote increased behavioral health services access. Cross-system considerations are identified for public health, court, and other key stakeholders to successfully integrate technology into practice to expand access to these critical services.

Bringing juvenile justice and public health systems together to meet the sexual and reproductive health needs of justice-involved youth.

Constitutional mandates require access to medical testing and treatment in correctional settings, including sexual and reproductive health (SRH) care services. These same mandates do not apply to youth supervised in the community, who represent the majority of justice-involved youth. Waiting until youth are in detention settings to provide access to SRH services misses an opportunity to improve health outcomes for youth who have earlier points of contact with the system. This mixed-methods study explored structural intervention development and policy geared toward increasing access to and uptake of SRH prevention, treatment, care, and support services for court-involved, nonincarcerated (CINI) youth. Data were collected from a nationwide survey (N = 226) and qualitative interviews (N = 18) with juvenile justice (JJ) and public health (PH) system stakeholders between December 2015 and January 2017. Results suggest both PH and JJ stakeholders perceive CINI youth as having substantial, largely unmet SRH care needs due to a lack of services, policies, or procedures to address these needs. Barriers to implementing programs and policies to improve SRH services for this population include limited resources (e.g., staffing, time); perceived irrelevance for juvenile court, probation, or other community supervision settings; and concerns about confidentiality, privacy, and information sharing. Recommendations for effective intervention included colocating services, justice-to-community referrals, and service linkages (e.g., through a community health navigator), and staff education around youth SRH confidentiality and information-sharing practices. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Exploring adults as support persons for improved pre-exposure prophylaxis for HIV use among select adolescents and young adults in the Deep South.

PURPOSE: Pre-exposure prophylaxis for HIV (PrEP) is an effective yet underutilized biomedical tool for adolescents and young adults' (AYA) HIV prevention due to barriers such as PrEP adherence. We assessed HIV prevention knowledge, attitudes and beliefs from adults who self-identified as a primary support person to an AYA. METHODS: We surveyed AYA primary support persons at an academic hospital. Univariate and multivariate regression analyses were completed to identify factors associated with the belief AYAs engaging in HIV-associated behaviors should use PrEP and willingness to support AYAs on PrEP. RESULTS: 200 primary support persons completed the survey. Participants were predominately female (77%) and black (56%). Nearly all primary support persons believed AYAs engaging in HIV-associated behaviors should take PrEP (94%) and 98% would support an AYA taking PrEP via transportation to appointments, assistance with refilling prescriptions, medication reminders, or encouragement. CONCLUSIONS: Primary support persons are willing to support AYAs using PrEP.

Predictors of cannabis use among first-time justice-involved youth: A cohort study.

BACKGROUND: Justice-involved youth use cannabis at higher rates than their same-aged peers increasing likelihood of adverse behavioral health consequences and continued legal involvement. This study examined individual level predictors of early onset use cannabis use (<13 years of age) and cannabis use initiation in the 12 months following first court contact. METHODS: Participants were 391 first-time justice-involved youth (56.9 % male; Mage = 14.6 years; 32.1 % White, 11.1 % Black, 14.7 % Other/Multi-racial, 42.2 % Latinx) and an involved caregiver (87.2 % female; Mage = 41.0 years). Baseline assessments captured individual level factors; cannabis use was assessed every four months post-baseline for 12 months. Primary analyses involved multivariable modified Poisson regressions and survival analysis. RESULTS: In multivariable models, youth who reported lifetime cannabis use (n = 188, 48.1 %) were older, reported alcohol use and positive cannabis use expectancies. Greater self-control and self-concept were associated with lower likelihood of lifetime cannabis use. Youth who initiated cannabis during the 12-month follow-up (n = 30, 14.8 %) tended to be older, White/non-Latinx, and to report more psychiatric symptoms (posttraumatic stress, externalizing, internalizing, and affect dysregulation), delinquent behavior, lower levels of self-control, poorer self-concept, greater drug use intentions and positive cannabis expectancies. In the multivariable survival analysis, affect dysregulation, internalizing symptoms, and more positive cannabis expectancies remained independently and positively associated with cannabis initiation. CONCLUSIONS: There is a critical and unique window of opportunity to prevent cannabis use initiation among first-time justice-involved youth. Research is needed to determine whether brief interventions that aim to modify expectancies about cannabis use reduce rates of cannabis initiation in this underserved population.

VOICES: An efficacious trauma-informed, gender-responsive cannabis use intervention for justice and school-referred girls with lifetime substance use history.

BACKGROUND: Girls have unique developmental pathways to substance use and justice system involvement, warranting gender-responsive intervention. We tested the efficacy of VOICES (a 12-session, weekly trauma-informed, gender-responsive substance use intervention) in reducing substance use and HIV/STI risk behaviors among justice- and school-referred girls. METHODS: Participants were 113 girls (Mage = 15.7 years, SD = 1.4; 12 % White, 19 % Black, 15 % multi-racial; 42 % Latinx) with a history of substance use referred from juvenile justice (29 %) and school systems (71 %). Study assessments were completed at baseline, 3-, 6- and 9-months follow-up. Primary outcomes included substance use and HIV/STI risk behaviors; secondary outcomes included psychiatric symptoms (including posttraumatic stress) and delinquent acts. We hypothesized that girls randomized to the VOICES (n = 51) versus GirlHealth (attention control; n = 62) condition would report reduced alcohol, cannabis and other substance use, HIV/STI risk behaviors, psychiatric symptoms, and delinquent acts. RESULTS: Girls randomized to VOICES reported significantly less cannabis use over 9-month follow-up relative to the control condition (time by intervention, p < .01), but there were no between group differences over time in HIV/STI risk behavior. Girls in both conditions reported fewer psychiatric symptoms and delinquent acts over time. CONCLUSIONS: Data support the use of a trauma-informed, gender-responsive intervention to reduce cannabis use among girls with a substance use history and legal involvement; reducing cannabis use in this population has implications for preventing future justice involvement and improving public health outcomes for girls and young women, who are at disproportionate health and legal risk relative to their male counterparts.